Rip­ple ef­fect

Re­search of­fice seen as turn­ing point in ER care

Modern Healthcare - - THE WEEK IN HEALTHCARE - Paul Barr

Aseemingly small move by the Na­tional In­sti­tutes of Health—cre­at­ing an Of­fice of Emer­gency Care Re­search—could have a big ef­fect on the qual­ity of care throughout a hospi­tal and also within a physi­cian’s of­fice.

In des­ig­nat­ing a team to work full time on shep­herd­ing emer­gency-care re­searchers through the process of ob­tain­ing fund­ing from the NIH, as it did last week, the NIH is en­cour­ag­ing more of the type of re­search that is not eas­ily done out­side of an emer­gency depart­ment. Emer­gency room care of­ten spans dis­ci­plines, and pa­tients are of­ten still very early in the treat­ment process, a time that can be im­por­tant to their re­cov­ery and re­lated re­search, ER care ex­perts say.

“We (are) call­ing it one of the great­est days in emer­gency medicine his­tory,” said Dr. San­dra Schneider, im­me­di­ate past pres­i­dent of the Amer­i­can Col­lege of Emer­gency Physi­cians and a pro­fes­sor of medicine at the Univer­sity of Rochester, N.Y. The cre­ation of the of­fice rec­og­nizes that emer­gency-care re­searchers have be­come skilled enough to war­rant more at­ten­tion by the NIH and that emer­gency-care re­search is unique, Schneider said.

The new of­fice, called OECR and pro­nounced like the word “ocher,” will not be award­ing its own NIH funds, but hav­ing an of­fice to cham­pion the area is go­ing to make it eas­ier and more likely for re­searchers from all dis­ci­plines to get pres­ti­gious NIH fund­ing in emer­gency care. The of­fice will help re­searchers fig­ure out how to ap­ply for funds and help the NIH iden­tify cross-cut­ting re­search ar­eas it may have missed pre­vi­ously, ex­perts say.

Dr. Wal­ter Koroshetz, act­ing di­rec­tor of OECR and deputy di­rec­tor of the Na­tional In­sti­tute of Neu­ro­log­i­cal Dis­or­ders and Stroke, said that while it’s dif­fi­cult to as­cer­tain how much NIH-funded emer­gency-care re­search is tak­ing place cur­rently, he would ex­pect that in 10 years the amount should be dou­ble or five times what it is now as a re­sult of cre­at­ing OECR.

Un­til the cre­ation of OECR, emer­gen­cy­care re­searchers were with­out a home at the NIH, hav­ing to ap­ply for fund­ing within a unit fo­cused on a sin­gle type of care for re­search that may also carry a heavy com­po­nent re­lated to a dif­fer­ent NIH in­sti­tute. For ex­am­ple, a re­searcher look­ing at an as­pect of chest pain might have to ap­ply for funds through the Na­tional Heart, Lung, and Blood In­sti­tute, even though chest pain can be in­dica­tive of any num­ber of con­di­tions, such as a psy­chi­atric dis­or­der, Koroshetz said.

He said that de­spite the lack of fund­ing abil­ity, OECR will have influence at the NIH given the ac­tive in­volve­ment of high-level NIH of­fi­cials and those who award re­search money. A steer­ing com­mit­tee over­see­ing the of­fice is com­posed of the di­rec­tors of the Na­tional In­sti­tute of Gen­eral Med­i­cal Sciences; the Na­tional Heart, Lung, and Blood In­sti­tute; the Na­tional In­sti­tute of Neu­ro­log­i­cal Dis­or­ders and Stroke; the Eunice Kennedy Shriver Na­tional In­sti­tute of Child Health and Hu­man De­vel­op­ment; and the Na­tional In­sti­tute of Nurs­ing Re­search. In ad­di­tion, the NIH Emer­gency Care Re­search Work­ing Group, with more than 20 mem­bers from close to 20 in­sti­tutes, cen­ters and of­fices, will co­or­di­nate the emer­gency-care re­search.

The of­fice will be a part of the Na­tional In­sti­tute of Gen­eral Med­i­cal Sciences and will be com­posed of a di­rec­tor, a deputy di­rec­tor and an an­a­lyst, ac­cord­ing to Koroshetz.

The cre­ation of OECR also is a sym­bolic vic­tory for emer­gency-care re­search. Emer­gency care is a rel­a­tively new dis­ci­pline, and early projects may not have been of high enough qual­ity to meet the stan­dards of the NIH for its fund­ing. But over time, emer­gency-care re­searchers have built their skills and the qual­ity of their re­search, Schneider said.

A turn­ing point in the recog­ni­tion of the value of emer­gency-care re­search came in 2006 with the pub­li­ca­tion of the In­sti­tute of Medicine re­port Hospi­tal-Based Emer­gency Care: At the Break­ing Point, said Dr. Arthur Keller­mann, who holds the Paul O’Neil­lAl­coa Chair in Pol­icy Anal­y­sis for Rand Corp., Santa Mon­ica, Calif. At a sub­se­quent House hear­ing con­ducted by the Com­mit­tee on Over­sight and Gov­ern­ment Re­form, leg­is­la­tors put the NIH on the spot re­gard­ing what it was do­ing to solve the prob­lems high­lighted in the IOM re­port, Keller­mann said.

NIH of­fi­cials then be­gan ad­dress­ing the mat­ter se­ri­ously, Keller­mann said. The NIH cre­ated a task force and held a se­ries of round­tables cul­mi­nat­ing in the an­nounce­ment last week. “The light kind of went on at the NIH.”

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